Improvements throughout the Three Waves of COVID-19 Pandemic: Results from 4 Million Inhabitants of North-West Italy

Abstract

At the very beginning of the European spread of SARS-CoV-2, Piedmont was one of the most affected regions in Italy, with a strong impact on healthcare organizations. In this study, we evaluated the characteristics and outcomes of the COVID-19 patients in an entire region during the first three pandemic waves, identifying similarities and differences in the SARS-CoV-2 epidemic's timeline. We collected the health-administrative data of all the Piedmont COVID-19 patients infected during the first three pandemic waves (1 March 2020-15 April 2020; 15 October 2020-15 December 2020; 1 March 2021-15 April 2021, respectively). We compared differences among the waves in subjects positive for SARS-CoV-2 and in patients admitted to ICU. Overall, 18.621 subjects tested positive during the first wave (405 patients/day), 144.350 (2366.4 patients/day) in the second, and 81.823 (1778.8 patients/day) in the third. In the second and third waves, we observed a reduction in median age, comorbidity burden, mortality in outpatients, inpatients, and patients admitted to ICU, in intubation, invasive ventilation and tracheostomy, and a parallel increase in the use of CPAP. Our study confirmed a trend towards younger and healthier patients over time but also showed an independent effect of the period on mortality and ICU admission. The appearance of new viral variants, the starting of vaccination, and organizational improvements in tracking, outpatients and inpatients management could have influenced these trends.

Keywords: SARS-CoV-2; comorbidity; epidemiology; intensive care units; mortality; patients.

Figure 1

Number of swabs performed, number of new SARS-CoV-2 positive cases registered in Piedmont during the COVID-19 pandemic, and main interventions issued by the Italian Government and the health care system. (Data source: GitHub—pcm-dpc/COVID-19: COVID-19 Italia—Monitoraggio situazione). ^a Spread of Delta variant.

Figure 2

Flow chart on data collection process by record linkage of three different regional-health administrative archives.

Figure 3

Mortality within 30 days from the first positive swab in hospitalized patients and in the subgroup of patients admitted to intensive care unit (ICU) in the three waves.

Figure 4

Odds ratio (OR) and 95% confidence interval (CI) estimates showing the effect of being infected in different waves on the combined outcome mortality and ICU admission, adjusting by age, gender, and comorbidity burden.